Healthcare Provider Details

I. General information

NPI: 1720476989
Provider Name (Legal Business Name): MICHAEL SEAN HUFFMAN PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270E POWELL RD
LEWIS CENTER OH
43035-8619
US

IV. Provider business mailing address

481 TRACE DR
DELAWARE OH
43015-7059
US

V. Phone/Fax

Practice location:
  • Phone: 614-432-6401
  • Fax: 614-543-1363
Mailing address:
  • Phone: 614-432-6401
  • Fax: 614-543-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number004490
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: